Rules for Missouri Ambulance Districts

XII. Personnel


ADs might not think of themselves as employers needing detailed personnel policies. An AD might have just one employee and work arrangements may be informal. However, even with a single employee, an AD is an employer. An AD must have federal and state employer identification numbers (EINs), withhold income and Social Security and Medicare taxes from wages, and pay state unemployment insurance. Moreover, an AD is considered a public employer. As such, an AD must keep certain records under the federal Fair Labor Standards Act, known as FLSA, and compensate employees in accordance with FLSA rules (see Chapter XIII. Federal Fair Labor Standards Act).

An AD could have employees who are covered by Social Security and others who are not. Today, most public employees are covered by Social Security, but this was not always the case. Some long-term public employees who were not covered by Social Security may have been “grandfathered” when laws changed.


In recent years, there have been many changes in laws that relate to employees. Most of the changes are the result of federal laws designed to eliminate discrimination. Only gradually have similar laws also been adopted at the state level. These overlapping laws can be confusing. In some cases, they apply broadly to all workers, including volunteers; in other cases, they apply only to employees, or they may apply only to workplaces with a minimum number of employees, which might be four, 15, 25 or 75, depending on the section of the law. Many federal laws always apply to a political subdivision such as an AD regardless of the number of employees or even if the AD has no employees.

An AD is not exempt from labor laws simply because it performs a public service. Rather, it should assume that all discrimination and employment laws apply, even if it has fewer than the “minimum number” of employees. Under modern civil rights legislation, including statutes sometimes referred to as “Civil Rights” or “1983,” (named for the legal citation, Title 42 of the United States Code, section 1983), an AD might be sued over AD conduct that is not otherwise covered by the specific statute. Damage claims can include attorney fees, which can be substantial, and often much higher than actual monetary damages awarded.

AD board members protect themselves by staying well informed and scrupulously following employment laws. A board may also want to consider insurance that covers its decisions as an employer. Most insurance products, including workers’ compensation, general liability and even board errors and omissions coverage, do not cover personnel or wage disputes. Insurance protection in this area requires separate, and perhaps expensive, employment liability coverage.

Special rule

AD board members act as a group, not as individuals. The AD board is the decision-making body. However, the board can assign duties to the EMS chief, other officials and employees that may involve what lawyers call “ministerial duties” to carry out the AD board’s policies. Moving from decision-making by the EMS chief or an entire group of EMTs and paramedics to a smaller group of directors on an AD board, some of whom may know little about EMS, often can be difficult, but that is the way our form of government works.

Employees and volunteers

Lawyers, legislators and courts use the terms “employee” and “volunteer” in different ways and telling them apart for legal purposes can be difficult. Volunteers, called unpaid employees by some, might receive a payment, such as a small honorarium called “show-up pay” when they attend a training session, or they might receive mileage or tuition reimbursement, especially when taking training far from home. Sometimes employees want to volunteer to go on medical calls—which they cannot do unless paid at their regular rate of pay or at time-and-a-half, depending on the situation (FSLA §3[e][4] [A]). Both employees and volunteers can be fired. Both employees and volunteers can be required to follow AD policies, and both can be required to wear a prescribed uniform. Also, an AD can be sued for the conduct of either type of worker.

When distinguishing between an employee and a volunteer, most will say that an employee is paid a “regular wage,” while a volunteer receives only “nominal compensation.” In 2007, the International Association of fire Chiefs (IAFC) asked the U.S. Department of Labor for more explicit guidelines clarifying who is an employee and who is a volunteer. In response, the Labor Department’s Wage and Hour Division provided a letter stating that a person would be considered a volunteer if he or she is paid less than 20% of what a full-time firefighter receives in the same locality. This 20% benchmark might also be useful to ADs in contexts beyond the authority of the Wage and Hour Division, such as minimum wage, overtime and compensatory time.

ADs have special circumstances

EMTs and paramedics, whether they are employees or volunteers, are given certain legal dispensation when responding to a call (300.100). This includes allowance to drive as fast as they think prudent, provided both lights and siren are working. However, EMTs and paramedics are not allowed to disobey stop signs or lights until after slowing down. Every year, EMTs, paramedics and other emergency personnel suffer serious injuries or line of duty deaths (LODDs) at stop signs or traffic lights. Occasionally an ambulance driver (or police officer or firefighter) is charged with manslaughter when a death results from running a stop sign. Also, an AD can be sued if one of its EMTs or paramedics causes a traffic injury or death by inattention to stop signs.

As a result of speed, and because an ambulance does not steer like a sports car, failure of EMTS and paramedics to wear seat belts and shoulder harnesses is particularly dangerous. Rollovers of top-heavy ambulances cause an appalling number of EMT and paramedic deaths and injuries.

Thus, it is important that ADs have rules requiring EMTs and paramedics to slow down or stop at every stop sign or red traffic signal and to wear seat belts and shoulder harnesses. The AD should discipline any EMT or paramedic, whether an employee or a volunteer, who fails to obey these rules, even when driving a private vehicle to the station or a scene.

(See Physical fitness section under Chapter XIV. Training, Physical fitness and Equipment for more information about preventing LODDs.)

Special EMT and paramedic benefits

It is hoped that you will never need this information in your tenure as an AD director, but you should be aware of special benefits that may be available to the families of EMTs and paramedics who suffer an LODD. The Missouri EMS Funeral Response Team helps emergency service organizations when an EMT or paramedic dies, even if the death did not occur during duty. If an EMT or paramedic dies, the employing AD should immediately contact this organization for guidance and assistance, including funeral protocols, a ?ag for the family, badge shrouds, station and vehicle bunting, honor guard uniforms, etc. There are also funeral protocols for the death of an AD director.

The federal government provides a death benefit (over $359,000 in 2019) to the family of an EMT or paramedic who dies in the line of duty or from a heart attack within 24 hours of a nonroutine stressful situation. The application for the benefit can require extensive medical records and is difficult to complete. The Missouri EMS Funeral Response Team can provide guidance to families in this situation. This application requires certain autopsy results to show the death was not caused by alcohol or drug abuse; so for this reason, the family should not release the body to a funeral home until after an autopsy.

Missouri provides two modest death benefits to the surviving spouse of an EMT or paramedic killed in the line of duty. (These benefits are also available to surviving spouses of firefighters, first responder or law enforcement personnel). The first benefit is property tax relief on the family home as long as the surviving spouse does not remarry. The relief is provided through a special income tax credit that must be claimed annually on the state income tax return (135.090, as currently written, will expire in 2027). The second benefit is a $25,000 death benefit from the Line of Duty Compensation Act (287.243, as currently written, will expire in 2025).

Other miscellaneous benefits may also be available. One of the nation’s large funeral home chains has been providing a free funeral service when an LODD occurs. Upon request, a uniform-manufacturing company has been providing a free dress uniform for the body of an EMT or paramedic. More information about these benefits is available from the Missouri EMS Funeral Response Team.

Hiring and firing the EMS chief

In addition to the powers listed in Chapter II. AD Powers and Duties, the board of an AD is authorized to carry out the work of the AD, including employing such help and contracting for such work as is necessary to provide service to the AD, and may pay reasonable compensation (190.060.1[6]). Hiring and firing the AD’s EMS chief is one of the most important duties of an AD board.

All persons employed by the board on behalf of the AD are, by law, at-will employees. This means they are employed for an indefinite term, which either employer or employee may terminate at any time, for or without cause

Expectations and evaluation of EMS chief

One of the most important duties of the AD is to appoint an EMS chief. EMS tends to be organized with a military-type command structure, and they are strongly in?uenced by the personality and level of competence of the EMS chief. The board should take seriously its role in selecting and working with the EMS chief, who will lead the AD’s day-to-day operations. When appointing an EMS chief, the AD board needs to communicate clearly and honestly with the candidates about its expectations. Once an EMS chief is appointed, the board should evaluate the EMS chief’s performance at least annually.

A sample EMS Chief’s Report to the AD board can be found in the Sample Forms section of this manual.

Generally, the EMS chief is expected to be prepared for and informed on all aspects of the job. During interactions with the AD board, the EMS chief should provide multiple options for the board to consider along with proposing recommendations to the board for the best options. One of the strengths a chief should have is the ability to communicate with all levels of the organization and, also, with the community, either in person or through the public media. And finally the EMS chief needs to understand and embrace the basic roles and responsibilities of the job, which can include:

  • Providing organizational leadership;
  • Overseeing daily management of the operations;
  • Overseeing the staff, although perhaps only the AD board may hire, fire and discipline;
  • Developing and recommending policies and standards to the AD board;
  • Implementing standard operating procedures or guidelines;
  • Overseeing implementation of strategic plan decisions;
  • Educating, informing and communicating important information to the AD board — both positive and negative news;
  • Keeping abreast of political, legal, financial and technological changes to EMS;
  • Ensuring compliance with AD, Missouri and federal laws, rules and regulations;
  • Analyzing AD needs and helping develop the AD budget;
  • Serving as an official AD ambassador of sorts and liaison to the public and media;
  • Cultivating relationships with other agencies, governments and organizations, such as, hospitals, cities, counties, fire protection districts, etc.; and
  • Overseeing, controlling and preserving AD resources and assets.

Workers’ compensation insurance

Laws require any organization with five or more employees to have workers’ compensation insurance to cover its employees (287.030). Volunteers have sometimes been construed as employees by the courts, so consult with legal counsel before assuming they are not employees for purposes of coverage. (See Oliphant v. St. Louis State Hosp., 441 S.W.2d 335 (Mo. 1969)). This insurance provides medical insurance coverage for an EMT or paramedic injured on the job, disability insurance coverage for an EMT or paramedic injured on the job, and a modest survivor benefit for the family of an EMT or paramedic killed on the job.

AD&D Insurance

For accidental death and dismemberment

A&S Insurance

For accidents and sickness

The workers’ compensation benefits that volunteer EMTs and paramedics might have at their regular jobs will not cover injuries from volunteering, so a separate policy by the AD is needed. Also, because private health insurance often excludes injuries that could be protected by workers’ compensation, many times the volunteer’s private health insurance will not pay. In addition, the disability and death benefits listed above for volunteer EMTs and paramedics are particularly modest because they are based upon a benefit of $40 per week. If a volunteer EMT or paramedic is injured on the scene, for example, an AD workers’ compensation insurance policy would pay all medical bills but would provide only $40 per week disability pay for the time the EMT or paramedic is unable to work during recovery. If the EMT or paramedic supports a family, they may have difficulty getting through the recovery period on so little money. (Many generous employers will permit an EMT or paramedic who suffers an injury to draw vacation and/or sick leave pay, but employers are not required to do this.) For these reasons, many ADs provide additional disability and death benefit protection for their EMTs and paramedics (190.060.1[10]).

Currently, several insurance companies that operate in Missouri provide specialized insurance coverage for EMS organizations. These companies are familiar with the workers’ compensation problems, and other insurance companies can be educated about the problems and urged to provide reasonable assistance.

Personnel policies

Workplace-related lawsuits do not happen often, but when they arise, they are unpleasant and can be extremely expensive, even for the winners. That is why employment liability insurance coverage is sold separately and why it is expensive. Employers have found that one of the best defenses available is to have a published handbook of employment policies that is scrupulously followed in all situations.

With this in mind, AD boards are encouraged, with advice and counsel from their attorney, to examine their existing written personnel policies, compare them with policies being used in neighboring ADs and review sample policies available from insurance companies or from reliable sources on the Internet. The board should put together a set of policies the AD can live with and realistically follow. Keep in mind, because a policy that is ignored is evidence that can be used against an employer, the board must follow the policies it adopts.

(See Licenses and certifications for EMS personnel under Chapter XIX. Ambulance Services for more information regarding the impact of medical licensing and certifications on personnel policies.)

Alcohol use

Historically, first responders were members of voluntary social groups. Being a first responder not only provided some community benefit, but also was a form of group camaraderie. Like many social activities, it was frequently accompanied by the use of alcoholic beverages. As EMS has become more complex, it has become more a professional, and less a social, activity. The risks of combining alcohol and EMS are obvious. AD board members and officers should be aware of the risks and ensure that alcohol is removed from the station if its use there is still allowed or condoned in the AD.

Minimum wage

Both Missouri and the federal government have enacted rules that govern minimum wages paid to non-volunteer workers. Laws also regulate the maximum number of hours a paid worker can work before the employer must pay an overtime premium (time-and-a-half).

Exemptions in state law for governmental entities to pay minimum wage should be carefully considered before being used. Positions with lower pay may be challenging to fill (290.502).

Child labor laws

Many ADs have “junior first responder” or Explorer scouting programs for younger members of the community. AD boards should be aware that laws enacted both by Missouri (294.005-150) and the federal government (Fair Labor Standards Act of 1938) regulate employment of children. Children may not work in hazardous conditions such as using power-driven machinery, maintenance or cleaning/washing of machinery, operation of any motor vehicle, and anything dangerous to life, limb or health — that is, many first responder activities.

Additionally, work certificates from the school district superintendent are required for children working during the school year, and there are limitations during the school year on how many hours children can work in a day and in a week.